Pivotal Response Treatment (PRT)

Report
PRT: The Marriage of ABA and
Speech-Language Pathology
Amy Fetter, MA, CCC-SLP
Karen Duerk, MA, CCC-SLP
Speech Language Pathologists
The Joshua School
The definition of PRT
• A comprehensive service delivery model that
uses both a developmental approach and
applied behavioral analysis (ABA) procedures
(Koegel, 2006).
Definition of ABA
• ABA is the science in which tactics derived
from the principles of behavior are applied to
improve socially significant behavior and
experimentation is used to identify the
variables responsible for the improvement of
behavior.
(Cooper, 2007)
7 Dimensions of ABA
1.
2.
3.
4.
5.
6.
7.
Applied
Behavioral
Analytic
Technological
Conceptually systematic
Effective
Generality
The goals of PRT:
• Teach learners to respond to the many learning
opportunities and social interactions that occur in
the natural environment;
• Decrease learners' needs for constant supervision
and interaction with adults;
• Promote family involvement and improve the
quality of life for all family members;
• Decrease the number of services delivered in
separate settings that remove learners from the
natural environment;
Autism Internet Modules | AIM Help Email:
[email protected]
Copyright © 2011 | OCALI is a project of the ESC of Central
Ohio
The goals of PRT Cont’d:
• Improve learners' academic performance,
communication and language skills;
• Foster learners' social interactions and friendships
with typically developing peers;
• Reduce learners' interfering behaviors (e.g.,
disruptive, repetitive, stereotypical);
• Move learners toward a typical developmental
trajectory by teaching a diverse number of behaviors;
and
• Broaden learners' interests.
Historically
PRT
Location of intervention
Segregated environments
Isolated mental hospitals
Natural environments
Inclusion with typical peers
Primary Intervention
Punishment/rewards
Restraints
PBIS
Focus on motivation
Stimulus
Artificial stimulus
i.e., flashcards
Motivational stimulus
i.e., toys, books
Generalization and
maintenance
Difficulty generalizing and
maintaining new behaviors
to outside environments
Increase in generalization
and maintenance of new
behaviors to outside
environments
Interaction
Human contact believed to
be aversive to children
with ASD
Human contact believed to
be comforting and
beneficial to children with
ASD
Historical Connection with ABA
• Distinguishing from DTT (Discrete Trial
Teaching)
• Basic principles of ABA used to teach
receptive, expressive language, play, self-help,
and social skills
– Reinforcement/punishment
– Shaping
PRT and modern ABA Principles
• PRT is using ABA strategies to increase
generalization and rapid, widespread effects
using these fundamental teaching tools:
– Reinforcement (PBIS)
– Antecedent control
– Prompting with strategic plans to fade
– Shaping
– Chaining
Treatment of the Pivotal Areas
1.
2.
3.
4.
5.
Motivation
Multiple cues
Initiation
Self- Management
Empathy (in progress)
Pivotal Area 1: Motivation (video clips AIM)
• Core motivational variables of PRT
1) Child choice
2) Establish learner attention
3) Direct (natural) reinforcement
4) Interspersal of maintenance and acquisition trials
5) Task variation
6) Reinforcing attempts
7) Overall motivational package
- Results Koegel, O’Dell, &Koegel, 1987
Increase in Generalization of Imitation
and Spontaneous Utterances
baseline
12 Months
20 Months
150
130
110
90
70
50
30
10
-10
DTT
PRT
Examples
• Making choices for daily schedule
• Working for reinforcement
• Choices for bonus time
• Social Communication
• Using motivating materials to teach language
Language/Motivation/Disruptive
Behaviors
Potential Goals for Motivation
1. When motivation is present, student will
spontaneously mand (request) 20 missing items
verbally, with sign, with PECS, or with SGD in at
least 80% of measured opportunities across 3
different people and 2 different settings.
2. When motivation is present, student will mand
(request) with 10 different adjectives,
prepositions, or 2+ word utterances to gain
access or protest in at least 80% of measured
opportunities across 3 different people and 2
different settings.
Pivotal Area 2: Responsivity to
Multiple Cues
• Global goal – decreasing overselectivity by
distinguishing multiple relevant features of
environmental stimuli.
• Provide wide range of cues in learning
environment.
• Implication for language acquisition and social
behaviors
Examples
Multiple cues with preschool
Potential Goals for Multiple Cues
1. When in the natural environment or when shown a
book, student will identify and label items based on 3
verbal components (adjectives, quantity, pronouns)
with at least 80% accuracy across 3 different people
and 2 different settings.
2. While engaged in the daily classroom routine (lunch,
art class, recess), student will follow directions that
include information about feature, function, and/or
class with 80% accuracy across 3 different people and
2 different settings.
Pivotal Area 3: Self-Management
Definition – PBIS strategy used to reduce problem behaviors while teaching
functionally equivalent replacement behaviors or to improve behavior
deficits through increasing appropriate positive behaviors.
Global Goal – teaching children to be aware of their behaviors and to increase
ability to self-monitor, modify, and reinforce their own behaviors.
Self- Management Procedures
1.
2.
3.
4.
5.
Operationally define and measure the target behavior
Set goals and identify reinforcers
Develop self-management method-device
Teach the child to use the self-management system
Fade the structured device.

Increases – on task behavior, social conversation behaviors, flexibility

Decreases – disruptive behavior, self-stimulatory behavior
Examples
• Token rewards for positive behavior
• Tally’s for not interrupting
• Positive behavior management initial stages.
Implementing with Student
1)
2)
3)
4)
5)
Present the plan
Provide definition of flexibility
Provide explicit instructions on how to obtain points
Model how to earn points
Provide self-management tools(stickers, markers, point
sheet)
6) Play the activity
7) Prime the child
8) Present flexibility opportunities
9) Child gives self point
10) Immediately reinforce the child
Troubleshooting
• Remind the child of the reinforcer
• Make sure reinforcer is powerful enough
• Make sure you’re starting with least
demanding task
• PBIS 
Potential Goals for Self-Management
1. When auditory prompt is sounded, student will
accurately provide himself appropriate
reinforcement for safe hands at the end of the
time interval in at least 90% of measured
opportunities across 3 different settings.
2. Using video review, student will independently
label non-verbal cues relating the
attention/interest of communication partner
using self-management worksheet with 90%
accuracy 3 videos per day for 4 weeks.
Pivotal Area 4: Initiation
• Question posed – What were the contributing
factors to having a good prognosis with ASD??
• Initiating with questions
– What’s that?
– Whose is it?
Where is it?
What’s happening?
• During groups strategically place
materials/students
60
50
40
30
20
10
0
Pre
Post
OBSERVABLE “NORMALCY”
IMPROVEMENTS
Child 1 Child 2 Child 3 Child 4
10
8
6
4
2
0
Pre
Post
Child Child Child Child
1
2
3
4
Potential Goals for Initiation
1. When motivation is present, student will initiate
a physical interaction with a peer 2 times in a 15
minute time sample across 2 different settings.
2. When interested in a peer’s toy or item, student
will initiate verbally by asking “Can I play?” or a
variation of such in at least 4 out of 5 measured
opportunities across 3 different settings.
Questions??
PRT: Best Practice for ASD
• Over 200 research studies to support its effectiveness
• Listed by National Research Council as one of the top 10
intervention models for ASD
• Recognized as one of 4 scientifically based practices for
treatment of children with autism in the US (Simpson article)
Research in Self-Management
Study 1: Increasing flexibility and maintaining high
affect
Study 2: Improving pragmatics in children with ASD
using video self-management
video-based interventions
- appropriate model
- self as model
- view and evaluate performance
- combined one or more of these with
other interventions
References
• Cooper, J, Heron, T. & Heward, W. (2007). Applied Behavioral
Analysis, 2nd Edition. Upper Saddle River, NJ: Pearson Education, Inc.
• Koegel, Robert & Koegel, Lynn (2012). The PRT Pocket Guide –
Pivotal Response Treatment for Autism Spectrum Disorders.
Baltimore, MD: Paul H. Brookes.
• Koegel, Robert L. (2010) .The History & Development of Pivotal
Response Treatment. Bresnahan Halstead Symposia, August, 2010.
• Koegel, Lynn & Koegel, Robert.,(2010). Pivotal Response Treatment:
Evidence-Based Practice. Bresnahan Halstead Symposia, August,
2010.
• Koegel, Lynn & Koegel, Robert. (2010).Teaching Initiations to
Children with Autism. Bresnahan Halstead Symposia, August, 2010.
References Cont’d:
• Koegel, Lynn & Koegel, Robert (2010). 10 Strategies to Improve
Socialization in Children with Autism. Bresnahan Halstead Symposia,
August, 2010.
• Koegel, Robert & Koegel, Lynn (2006). Pivotal Response Treatments
for Autism: Communication, Social, & Academic Development.
Baltimore, MD: Paul H. Brookes.
• Achieving New Heights: Evidence-Based Strategies to Promote
Communication, Social, and Behavioral Growth for Individuals Who
Have Autism, July 26-30, 2010.
• Simpson, R. (2005). Evidence-Based Practices and Students with
Autism Spectrum Disorders . Focus on Autism and Other
Developmental Disabilities, 20: pp. 140-149.
• VB-MAPP – Language Intervention Program Based on Verbal
Behavior Curriculum, August 28, 28, 2010.
Thank you!
• Thank you to students and staff who
participated in providing videos!

similar documents